As a disc degenerates, the soft inner gel in the disc can leak back into the spinal canal. This is known as disc herniation, or herniated disc. Once inside the spinal canal, the herniated disc material then puts pressure on the nerve, causing pain to radiate down the nerve leading to sciatica or leg pain (from a lumbar herniated disc) or arm pain (from a cervical herniated disc).
Herniated Disc Facts
- The discs are pads that serve as “cushions” between the vertebral bodies, which minimize the impact of movement on the spinal column.
- Each disc is designed like a jelly donut with a central softer component (nucleus pulposus).
- Abnormal rupture of the central portion of the disc is referred to as a disc herniation.
- The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumbar vertebrae in the low back.
- If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation.
- The physical examination, imaging tests, and electrical tests can aid in the diagnosis of a herniated disc.
- Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medication, anti-inflammation medications, chiropractic care, local injection of cortisone (epidural injections), and surgical operations.
Signs and Symptoms
- So how do you know if you have a herniated disk and not just regular old back pain?One sign may be where the pain is located. Although they can occur in any part of your spine, herniated disks are most common in the lower part of your backbone (the lumbar spine), just above your hips. And the pain may spread from your back to your buttocks, thighs, even to your calves.Discomfort from a herniated disk usually worsens when you’re being active and lessens when you’re resting. Even coughing, sneezing, and sitting can aggravate your symptoms because they put pressure on the pinched nerves.Age also plays a factor. As you get older, your disks tend to break down and lose their cushioning.
The primary goal of treatment for each patient is to help relieve pain and other symptoms resulting from the herniated disc. To achieve this goal, each patient’s treatment plan should be individualized based on the source of the pain, the severity of pain and the specific symptoms that the patient exhibits.
In general, patients usually are advised to start with a course of conservative care (non-surgical) prior to considering spine surgery for a herniated disc. Whereas this is true in general, for some patients early surgical intervention is beneficial. For example, when a patient has progressive major weakness in the arms or legs due to nerve root pinching from a herniated disc, having surgery sooner can stop any neurological progression and create an optimal healing environment for the nerve to recover. In such cases, without surgical intervention, nerve loss can occur and the damage may be permanent.
There are also a few relatively rare conditions that require immediate surgical intervention. For example, cauda equina syndrome, which is usually marked by progressive weakness in the legs and/or sudden bowel or bladder dysfunction, requires prompt medical care and surgery.
Conservative and Surgical Treatments
For lumbar and cervical herniated discs, conservative (non-surgical) treatments can usually be applied for around four to six weeks to help reduce pain and discomfort. A process of trial and error is often necessary to find the right combination of treatments. Patients may try one treatment at a time or may find it helpful to use a combination of treatment options at once. For example, treatments focused on pain relief (such as medications) may help patients better tolerate other treatments (such as manipulation or physical therapy). In addition to helping with recovery, physical therapy is often used to educate patients on good body mechanics (such as proper lifting technique) which helps to prevent excessive wear and tear on the discs.
If conservative treatments are successful in reducing pain and discomfort, the patient may choose to continue with them. For those patients who experience severe pain and a high loss of function and don’t find relief from conservative treatments, surgery may be considered as an option.